Understanding Skin Harvesting for Skin Cell Suspension Autografts and Coding Guidelines

Jan 21, 2025

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8 min read

Nelluri Gopala Rao, Sivakumar Mani

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In the United States, about 40,000 patients are treated for thermal burn wounds. Skin grafting is the current treatment option where autologous donor skin is excised, and grafting is done on the wound area. This works well for burn wounds with large areas. To avoid extracting large areas of donor skin, meshing is done, but it comes with the possibility of complications like hypertrophic scarring and dyschromia. Skin cell suspension autograph is a better option when the burn wound is not large.

Skin Cell Suspension Autografts

Autologous skin cell suspension (ASCS) is a medical procedure through which a small portion of about one square centimeter of a patient's skin is harvested. The epidermal cells are extracted from the harvested skin processing with the proteases, and these cells are sprinkled on the area of the wound bed at a ratio of 1:80. This ratio is comparatively larger than the traditional mesh repair, where the ratio reaches a maximum of 1: 6.

Advantages of Skin Cell Suspension Autografts

Enhanced Wound Healing

Accelerated Epithelialization: ASCS facilitates faster re-epithelialization by providing a concentrated source of keratinocytes, melanocytes, and other essential cells necessary for skin regeneration.

Improved Cellular Distribution

The epidermal cell suspension allows even distribution of cells across the wound, promoting uniform healing and lowering the risk of hypertrophic scarring.

Lower Risk of Infection

Faster epithelialization decreases the duration of wound exposure, reducing the risk of infection and related complications.

Decreased Healthcare Burden

Faster healing and low chances of infection reduce hospital stays and lower healthcare costs.

Reduced Wound Care Needs: Improved healing reduces the frequency and duration of wound care interventions.

A Small Area of Excision

The area of skin excised can be as small as one square centimeter, which facilitates quicker healing for the donor site.

How are the Skin Cell Suspension Autografts (SCSA) Obtained?

The RECELL system is a single-use, autologous cell harvesting device that uses a donor skin-sparing approach to prepare a regenerative autologous skin cell suspension (ASCS) that supports the restoration of skin wounds. This approach converts the extracted skin to ASCS, which includes disaggregated keratinocytes, fibroblasts, and melanocytes, which are much needed for tissue healing and pigmentation. The prepared ASCS, combined with widely meshed STSG for full-thickness skin wounds, is applied to a clean, vascularized wound bed using a spray technique. The one sq cm of skin is used to prepare 1 ml of cell suspension for treatment of up to 80 cm2 of the wound area. This treatment approach promotes epidermal regeneration for definitive wound closure, minimizing donor skin requirements and their associated burden.

RECELL Autologous Cell Harvesting Device and Approval from the FDA

The RECELL Autologous Cell Harvesting Device is a notable example that processes autologous skin samples into a cell suspension for direct application or use with meshed autografts.

Skin Cell Suspension Autografts Coding Guidelines

The American Medical Association (AMA) has designated specific Current Procedural Terminology (CPT) codes for these procedures, effective January 1, 2025.

There are three steps to performing the SCSA procedure: Harvest, Preparation, and Application, with specific codes for each procedure.

Reimbursement Guidelines

MPFS Guidelines:

2025 National Physician Fee Schedule Relative Value File January Release.

Status Indicator:

C: Contractors price the code.
A/B MACs (B) will establish Relative Value Units (RVU) and payment amounts for these services.

Global Days:

Graft Application Procedures: 90-day global period (090). This includes a 1-day preoperative period and a 90-day postoperative period.
Graft harvest Procedure: “0” same-day global period (000). This means that all related preoperative and postoperative services are included in the payment for the day of the procedure only. Evaluation and management services on the procedure day are generally not payable.
Graft Preparation Procedure: XXX=The global concept does not apply to the code
Add-on Codes: ZZZ=The code is related to another service and is always included in the global period of the other service

Multiple Procedure (Modifier 51):

Multiple Procedure (Modifier 51): All primary codes for harvest, preparation, and application have a "2" indicator, meaning standard multiple procedure payment adjustment rules apply. A 50% payment reduction applies when these procedures are performed with other procedures in the same operative session.
Bilateral Surgery (Modifier 50): This does not apply to these procedures.
Assistant at Surgery (Modifiers 80, 81, 82, AS): Statutory payment restrictions apply. An assistant at surgery may not be paid.
Co-surgeons (Modifier 62): Not permitted for these procedures.

Team Surgery (Modifier 66): Not permitted for these procedures.

OCE Guidelines:

OCE stands for Outpatient Code Editor. It's software used by the Centers for Medicare & Medicaid Services (CMS) to automatically check the accuracy of medical billing for hospital outpatient services, such as skin harvesting. The OCE automatically verifies that the HCPCS codes provided are valid, correctly used, and supported by medical documentation. This ensures fair reimbursement for healthcare providers by minimizing payment errors. The OCE guidelines, updated regularly in the I/OCE Quarterly Data Files, provide detailed instructions on how to correctly code and bill for these procedures.

‍Ambulatory Surgery Center (ASC) Reimbursement Guidelines:

Ambulatory Surgery Centers (ASCs) are healthcare facilities that provide same-day surgical care, including procedures like skin harvesting for SCSA. ASC reimbursement guidelines dictate how these facilities are paid to provide services related to SCSA skin harvesting. Understanding these guidelines is essential for ASCs offering SCSA skin harvesting to ensure they receive appropriate reimbursement for the specialized care they provide.

G2-Non office-based surgical procedure, payment based on OPPS relative payment weight
N1-Packaged service/item; no separate payment made
R2-Office-based surgical procedure, payment based on OPPS relative payment weight

Conclusion:

Effective January 1, 2025, the American Medical Association (AMA) has established specific Current Procedural Terminology (CPT) codes to standardize the reporting and billing of SCSA procedures.

These codes cover three distinct steps: harvesting, preparation, and application. Reimbursement guidelines, including the 2025 National Physician Fee Schedule Relative Value File and OCE Guidelines, provide specific payment information for each CPT code.

While SCSA is a significant advancement in burn treatment, it's crucial to remember that specific coding and billing guidelines must be followed to maintain payment accuracy. This article highlights the importance of accurate documentation while coding to ensure appropriate reimbursement and reflect the specific procedures performed.

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Stay tuned with CoverSelf for detailed sections on specific billing and documentation guidelines for CPT changes in 2025.